Celiac Disease and The Overuse of Antibiotics | Chris Kresser

Has Antibiotic Overuse Caused a Celiac Disease Epidemic?

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Celiac disease is on the rise, and the population-wide overuse of antibiotics could play a key role in triggering disease onset.

gluten free antibiotics
Antibiotic overuse may be the cause of the prevalence of celiac disease. Tuned_In/iStock/Thinkstock

There’s no denying that celiac disease (CD) is more prevalent now than ever. In the US, rates of CD have increased at least 5-fold over the past few decades, and prevalence in Finland has doubled. (1, 2, 3) The incidence of CD has also increased four-fold in the UK and three-fold in the Netherlands in the past 20 years, and the incidence of pediatric CD in Scotland has increased 6.4-fold. (4, 5, 6)

So naturally, everyone is wondering – why? We know that there’s a strong genetic component to celiac disease (and our ability to detect the disease has vastly improved), but the rising rates have occurred too quickly to be explained by a genetic shift in the population.

Besides, the genes that predispose an individual to CD are actually relatively common in the population, but only a very small percentage of those people actually develop the disease. In other words, genetics appear to be necessary – but not sufficient – for someone to develop CD.

Can the overuse of #antibiotics trigger celiac disease?

Antibiotics Can Cause Intestinal Dysbiosis and Infection

Clearly, something has changed in the environment to trigger celiac disease in a higher proportion of genetically susceptible people. Multiple factors probably play a role, but evidence indicates that one big factor is the intestinal microbiota. And a major contributor to disordered intestinal microbiota is antibiotic overuse.

In my previous article on the effects of antibiotics, I reviewed several studies that demonstrate how drastically antibiotics can alter the gut microbiome. Just a single course of antibiotics can reduce the richness and diversity of the intestinal microbiota, and in many cases, people never completely regain the diversity they lost.

Even if a person doesn’t develop an overt, clinically-diagnosable infection such as C. difficile, imbalances in the types of bacteria that colonize the gut can still cause serious problems. But to understand how antibiotic-induced gut dysbiosis could trigger celiac disease in genetically-susceptible individuals, it helps to first understand some of the basic mechanisms behind celiac disease.

Celiac Disease Involves an Immune Reaction to Both Gliadin and Tissue Transglutaminase

The biological mechanisms behind celiac disease are complicated and still not fully understood, but the general idea is that gluten – a group of proteins found in wheat, rye, and barley – triggers an autoimmune response that results in severe damage to the epithelial lining of the intestine.

Gliadins and glutenins are the two main components of gluten, with gliadins being the primary trigger for celiac disease. These proteins are very difficult for the body to digest fully, but in most people, this isn’t a problem. However, in people with celiac disease, certain cells (known as “antigen-presenting cells”) get a hold of these large, undigested fragments of protein and present them to T-cells, triggering an immune response. (7, 8)

An enzyme called tissue transglutaminase (TG2) is also important in the development of CD. This is because antigen-presenting cells only bind certain types of proteins, and they don’t usually bind normal gliadin fragments. (9) On the other hand, TG2 readily binds gliadin, and actually modifies it to make the gliadin much more attractive to antigen-presenting cells. This vastly increases the likelihood of an immune response.

Once this happens, the body starts creating antibodies against gliadin. But because the gliadin is usually bound to TG2, the body also creates antibodies against TG2, its own enzyme. This attack of “self” is what earns CD the classification of “autoimmune.”

Intestinal Dysbiosis and Infection Can Lead to Up-Regulation of Tissue Transglutaminase

In healthy individuals, TG2 plays a role in tissue repair, as well as in other processes such as regulation of cell death; it’s not an enzyme that’s “supposed” to interact with gluten. (Interestingly, TG2 also plays a role in other diseases, such as Parkinson’s and Huntington’s, by modifying proteins that it isn’t supposed to modify.) (10)

Most TG2 appears to be either stored safely inside cells or inactive under normal conditions, and is only activated in the event of tissue injury, bacterial or viral infection, or another source of inflammation. (11, 12) This indicates that tissue damage or inflammation in the intestine (and subsequent TG2 up-regulation) might actually be necessary for the development of CD.

Without substantial TG2 activity, it’s unlikely that the antigen-presenting cells would bind and present enough gluten fragments to provoke a major immune response. But a bacterial or viral infection could create inflammation and tissue damage that would activate TG2, and thus trigger the cascade of events eventually leading to celiac disease.

Intestinal Dysbiosis and Infection Can Contribute to Leaky Gut

Another factor to consider is the location of tissue transglutaminase. Nearly all TG2 is found in the sub-epithelial region of the intestine, a place that gluten shouldn’t have access to. This means the intestinal barrier would need to be compromised in some way for gluten proteins to significantly interact with TG2. (13)

This fits with previous work done by researchers such as Alessio Fasano, who have hypothesized that a person cannot develop an autoimmune condition such as CD if they don’t have leaky gut. If the intestinal barrier is intact, the immune system will never “see” the antigens, so it won’t mount an immune response.

But one big risk factor for developing leaky gut is intestinal dysbiosis or infection. Bacterial components such as lipopolysaccharides can induce inflammation and increase intestinal permeability, which would allow gluten into the sub-epithelial region of the intestine where it could be modified by TG2 and trigger CD. (14)

Candida Infection May Trigger Celiac Disease through Cross-Reactivity

So far, we’ve been talking about dysbiosis in a general sense, but there’s evidence that specific microbes could trigger celiac disease as well. A recent study (hat tip to Questioning Answers for the find) found that an overabundance of the yeast Candida albicans could contribute to the development of CD, and unfortunately, antibiotic use is a big risk factor for developing a candida infection. (15)

Candida is a normal part of the intestinal microbiome of healthy individuals, but problems can arise when it overgrows relative to other inhabitants of the intestine. Remember how tissue transglutaminase (TG2) readily binds gliadin? Well, it turns out that candida expresses a protein named Hwp1 that also binds TG2, potentially leading to immune activation and cross-reactivity with gluten.

The study found that people without CD who had candida infections produced anti-gliadin antibodies, as well as the expected anti-Hwp1 antibodies. People with CD produced antibodies to both proteins as well. This means that in theory, a person who is genetically susceptible to CD but who doesn’t have the disease could develop the disease in response to a candida infection.

So, What Does This Mean for You?

As you can see, there are several ways in which antibiotic overuse and subsequent intestinal dysbiosis or infection could lead to the development of celiac disease. As I’ve said before, antibiotics can be lifesaving and are necessary in some situations, but that doesn’t mean they’re free of consequences.

It’s becoming more and more clear how vitally important it is to use antibiotics responsibly, whether that’s not using them at all, or properly rehabilitating the gut during and after a course when they’re deemed necessary.

176 Comments

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  1. Remember when it was thought that MS might be caused by bacteria penetrating into the brain through a weak spot behind the nose? This was based upon the data that newly-diagnosed MS cases had a higher probability of having had a severe sinus infection in the prior 6 months, compared to the population in general. Scientists in medicine tend to do this unscientific thing of not understanding association does not imply cause. They also tended to believe that antibiotics saved so many lives they had no side-effects. So they were handed out like candy. It would have been a far better hypothesis that the sinus infection caused antibiotics to be prescribed and then. antibiotics were the cause of MS, an autoimmune disease. About time those hi tech probiotics were available which fight the other battle of clearing up the collateral damage to the human organism’s essential organ, the gut flora. Isn’t replanting the gut bacteria currently the only high-success rate treatment for c-difficile

    • Not sure of the success rate, but it is possible to buy pro-biotics, including the beneficial yeast, Saccharomyces Boulardii. This was discovered on the skins of lychees and rambutan fruit over 50 years ago and used to combat C. Diff.

  2. We look back at photo’s of my daughter and can see (and remember) clearly that it was after her illness with Whooping Cough & Pneumonia (and two courses of antibiotics) when she first started to progressively decline in health. Side note, she had been vaccinated for Pertussis too, by the way and still contracted the horrible virus – age 8. Additionally, she was a former extreme preemie (23 weeks), and her “First Food” post birth was an antibiotic for suspected sepsis. She received many more rounds in her first three months of life… and they saved her life, no doubt. All was good until age 8. Now 15 and struggling – cannot eat any grains, has to avoid all dairy, eggs, soy, peanut, and artificial ingredients and her worst allergen is Xantham Gum. My feelings, perfect storm/combination of antibiotic use during the time of GMO (glyphosate) consumption causing severe gut dysbiosis.

    • Dawn consider looking at the GAPS Diet by Natasha -Campbell- McBride. It is designed to help rebuild/ restore ones intesinal track. I had a history of over prescribed antibiotics which led to chronic constipation which led to diverticulosis. The info Natashs offers has been totally right on. Best of luck to you and you daughter in finding what works.

      • Thank you for your reply Sylvia! Just reading it now 2-22-16. I have read the GAPS book and have followed the diet with her (mostly) several times. We have started it over and over after she gets really ill – thinking each event is her rock bottom. Following a contamination, I start up with GAPS, I can usually get 10 days with her, but then she jumps right back into eating sugar! She will be 16 in a couple weeks and we have been trying to convince her to stop sugar for a year and a half. I stopped eating sugar (gluten, diary and artificial ingredients too) to show her it can be done and that she will always have my full support!

    • Your daughter’s food intolerances look exactly like mine. I want to give you a thumbs up about all the food prep you must be doing to keep your girl nourished. I get it.

      • Thank you for your encouraging words Heather! It is a lot of work and I am getting tired of it, but will keep forging on (prepping and cooking) because I can see the light… she is learning how to cook now and that has already brought me some relief! Also, the dietary changes we had to make for her, I made for my whole family and because of that, my whole family’s health status has improved immensely! Especially my husband! No more dizziness, headaches, anxiety, or acid reflux for him AND he has lost 50 pounds, has more energy than I have seen him have in the past 20 years! Something good always comes, even out of the seemingly bad things!

  3. I have a few questions.

    1. How do we avoid Lipopolysaccharides?

    2. How is Dr. Fasano’s theory of autoimmune disease and intestinal permiability panning out?

    I ask because I am on the fence about beginning LDN. I have been giving it ALL I’VE GOT for the last 2.5 years with lifestyle and gut healing interventions. I have made some progress, but no remission. My quality of life is quite compromised with an inablitly to travel if I do not have a kitchen, and the time I spend planning, preparing and cleaning up after cooking 3 meals a day has a huge impact on my life. Wondering if I just have more gut healing to do or if LDN will finally help get my immune system off my tissues…

    • Addressing SIBO, dysbiosis, and other gut pathologies and sealing the gut barrier would reduce your exposure to LPS.

      I can tell you that in most cases of autoimmune disease that I’ve worked with (very common in my practice), gut pathologies including intestinal permeability are the rule, not the exception.

      Anecdotally, we’ve seen very good results with LDN for many different AI conditions.

      • Thank you Kris, for your timely reply. I am going to keep on keeping on, healing, recolonizing and sealing my gut.

          • Very cool Lisa. I’ll check out your site. I have a little hot plate and cutting board based ‘kitchen in a bag’ for hotel rooms that don’t have a kitchenette. We also are putting more mileage on our camping trailer, because it has a kitchen…I have often thought about an AirBnB for grain free/dairy free folks…

  4. I think antibiotics are probably part of the problem…I feel that we can ultimately solve this issue by keeping our gut flora in balance. I have had chronic lyme and done several courses of antibiotics which lead to yeast overgrowth and just the early phases of celiac’s….I have solved all my past issues with apple cider vinegar. My opinion is clearly based on personal success. I am healed!

  5. Thank you for the article, Chris. Do you happen to know if anti-biotic eye drops affect the gut? I’m considering Lasik, but I’d have to take them and a steroid eye drop after. Thanks!

    • re: … if anti-biotic eye drops affect the gut?

      If it can into the eye, it can get into the body generally, and via the tear ducts, it can into the throat pretty easily.

      The precautionary principle says: if you have to do a course of antibiotic, also do a course of a quality probiotic*, and probably take the PB for at least 2 weeks after the AB ends.

      As it happens, I just started an AB for a dental procedure, and have started a PB as well.
      ______
      * The vast majority of probiotics on room temperature store shelves are not quality products.

      • The majority of probiotics are poor quality or dead.

        I switched to Thorne shelf stable probiotics – excellent quality brand and I was tired of concerns about the refrigeration issue. Thorne are also resistant to stomach acid so they get to the gut where they can do their work. They are expensive, but for an affordable brand my nutritionist recommends KyoDophilus 9 (must have the 9 meaning 9 strains) which are also shelf stable.
        We also use OrthoMolecular probiotic powder in packets, also shelf stable. Two people can share each packet to save cost.

        The point is, switch it up using different brands (unless you find a particular one that solves an acute issue you are having). and of course refrigerated sour kraut and other properly fermented foods.

  6. I absolutely agree with all of this. I have been on antibiotics more times than I can count beginning in early childhood. I’ve also struggled with Candida, food sensitivities, and then was finally diagnosed with Celiac Disease.

  7. Yes ever since I was in my early teens, I would get strep throat and be on antibiotics. I would get strep several times a year till I was in my late twenties and then got my tonsils taken out and never (touch wood) have had strep since. I do have celiac disease and have been Gluten free now for eleven years, but now I get terrible stomach pains, nausea, head aches, high blood pressure when I am around ,when something is being cooked or baked with wheat. I can not be in a house if someone is making toast or baking with wheat, cannot go to a grocery store if they are making pizza or baking in the bakery, etc…it totally limits to where I go and when. I always have to ask before I go to a friends house to see if they will be cooking or baking with wheat. Also can not go into a restaurant unless the kitchen has their own Google ventilation system so the wheat does not circulate in the whole restaurant…..urrggggg it is crippling and it sure is a handicap!! I have to wear a good mask if I happen to go somewhere where there is wheat baking or cooking and am quick as possible to get out….have you or anyone heard or know of this severe reaction? I would like to know because I feel I’m walking all alone and would be nice to have some support and some kind of education on this?! Thanks for your time…..Katri

    • Hi Katri!

      I have a similar history as you, and am very sensitive (although not like you!) I really feel for your situation and hope very much that you find the answers you need! A few of the symptoms you mentioned caught my eye, and I suggest HIGHLY that you read the book Stop the Thyroid Madness (on amazon) as well as some of the blogs on Chris’s website about the HPA access and thyroid. Thyroid and adrenal problems can greatly magnify symptoms of dysbiosis and food allergies. Chronic food allergies can in fact bring these imbalances in your endocrine system on, AND have symptoms of their own that you could be missing or mistakenly assign to just the allergy itself. Forgive me as I do not have information on your complete history, you may have already explored this angle? The book I recommended has EXCELLENT tips on diagnosis and is written by and for patients, so it makes these connections simply and clearly. I sincerely hope this helps get you in the right direction and I send you love and good wishes! Don’t give up! follow the trail, go get your health back, and then share it with others, especially parents so that people like you and I can give the ones after us a chance to have a better life!!

  8. I think the comment from Dr Jeff needs further consideration. I would advance the discussion if we would not focus on just one thing. All allergies, intolerances etc. are multi factorial with one or more triggers. Blaming the trigger isn’t very useful. In a worst case scenario you get rid of the symptoms but the real cause(s) not being addressed, it goes underground and becomes low level inflammation.
    Glyphosate has been used increasingly in the production of all our food. Yes, also on wheat, a common practice to speed the dying off.

    • As I said above, I’m not suggesting that antibiotics are the single cause of CD. CD, like most diseases, is multifactorial and involves a combination of genetic predisposition + environmental factors, of which antibiotic use is only one.

  9. Whoa, this is also based on some BIG assumptions as a bit more historical celiac testing background is needed. Missing in this discussion is that up until quite recently, CD was 1) not being diagnosed (not even being looked for) or 2) was being mis-diagnosed depending on the specialist (as schizophrenia, brain ataxia, depression, chronic fatigue, fibromyalgia) especially in the US, or 3) was only being diagnosed at end stage 3 of villous atrophy. At lot of this has a lot to do with older test methods, where only the blood of full blown celiacs were used as the sample medium. Intestinal sampling, the supposed gold standard of testing until recently, can also be faulty, as surface area of the intestinal lining is quite large, and the sample is small. Again, disturbance may not show until end stage atrophy already occurred.

      • Dunno what article you are reading, but there may not be as dramatic an increase in celiac, as it was hardly being looked for or diagnosed pre-1998 or so.

        There is, however, a clear and steep increase in non-celiac gluten sensitivity (NCGS), and autoimmune components. This one may be coming from various causes, including so-called safe gmo foods, toxic pesticides on standard produce, antibiotics, herbicides that act as antibiotics, and eating animal protein where these animals have been given repeat doses of antibiotics and also eaten pesticide laden grains.

  10. I also heard that CD is on the rise due to the higher gluten content in modern wheat and also GMO component of pesticide.

    • re: I also heard that CD is on the rise due to the higher gluten content in modern wheat …

      Modern runt mutant goatgrass (sold to you as semi-dwarf hybrid wheat) actually has less gluten than emmer, an heirloom grain. Modern wheat has different proteins, and the gliadin in particular may be different and more hazardous, but the total amount of it hasn’t changed that much.

      re: … and also GMO component of pesticide.

      ?
      There are no GMO wheats on the market [yet], if that’s what you were trying to get at.

      But yes, pesticide uptake is a problem. Even though there is no RoundUpReady wheat on the market, glyphosate is still used egregiously for “dessication” of wheat (terminating growth for harvesting convenience). The RoundUp obviously gets into the plant, because it kills it.

      Just another felony on the wheat rap sheet.

  11. Interesting article.

    Reading it makes me wonder if people should get a sample of gut bacteria taken before a course of antibiotics so that they can get the bacteria back in to their gut once they stop the course. Of course, that kind of relies upon being able to conserve the bacteria while on the antibiotic course and then being able to get them to repopulate the gut.

    From a personal perspective, I’m also wondering if the wrong types / balance of gut bacteria can significantly influence the cholesterol levels in the body.

  12. I am celiac, and previously had antibiotics (very strong ones) to help fight a gum infection. They made me feel really ill at the time, and I chose to stop one kind (they gave me two different ones). Previous to my diagnosis I had lots of antibiotics for strep throats etc. I noticed that severe symptoms occurred after I had Rota Virus. I was never the same, took me a long time to get over it. I think antibiotics exacerbate, but personally for me, I believe either pregnancy or Rota Virus trigger a celiac response….

  13. Definitely the cause in my case. I had continuous courses of antibiotics as a baby and until 7 years old and lots as a teenager. I noticed that I always got candida after taking them so avoided them as an adult. I had a course 6 years ago for a bad infection and immediately my health started to break down and I’m still fighting to get back to health. Lab tests show my beneficial bacteria are almost non existent and I have leaky gut. I’ve been clinically underweight all my life and I think that is due to the damage to my gut flora caused by antibiotics.

      • Yep, yes I have heard from plenty gluten intolerant Americans that they do fine in Europe without being on a GF-diet….

  14. My serious celiac symptoms started after a colitis infection. But after I had been gf for a while, I noticed that symptoms that had been mildly annoying my entire life had disappeared. I also had a negative blood tests (multiple one, actually), but a positive endoscopy. So I often worry that people are going undiagnosed, especially my children. I keep them mostly gf, just in case. Sparing them the trouble I’ve endured is worth the trouble and the expense.

  15. My daughter was diagnosed with Celiac at 2 1/2 yrs. she started exhibiting symptoms when she was about 22 months. I was on many antibiotics as a pre-teen and teenager. Could a mother’s antibiotic use contribute to her child’s development of the disease?

    • My daughter was diagnosed with Celiac at age 5. She started showing symptoms possibly as early as 19 months. She has only been on antibiotics once in her life when she was 5. However, I was on lots of antibiotics for strep infections in my life. I also wonder about a mother’s antibiotic use and/or antibiotics in the food supply.

  16. This also implies that CD could resolve if intestinal barrier function is restored.

    Are there any cases of CD resolving?

      • can you provide some direction of what to take instead for ear infections for children under 5 instead of antibiotics? Are there antibiotics brands that are “safer”?

      • Yes. It is due to antibiotics. I take massive amounts of probiotics daily (if the bottle says “one a day” I take 5, 3 times a day, and so on) and try to eat fermented foods. While I don’t think I will ever be able to completely heal my stomach due to antibiotic “abuse”, I feel like I can eat a piece of (organic/homemade/”clean”) toast now without becoming “drunk”. Sure, spraying roundup on wheat getting ready to be harvested is an abomination, and other factors are contributing, but when the body is in a state of constant dysbiosis, when the microbiome is not at its best, the whole world is going to be a threat.

    • re: This also implies that CD could resolve if intestinal barrier function is restored.

      Probably not, sort of by definition. Fasano has shown that the gluten-bearing grains cause intestinal porosity in everyone, not just those predisposed to CD. If the leakage stops, and you think you’re CD-free, re-exposure to wheat & its co-conspirators just starts the whole cycle all over. By the way, lectins in other grains may be nearly as troublesome.

      re: Are there any cases of CD resolving?

      The symptoms and side effects subside by going GF. Cured? perhaps not, but does it matter? Rhetorical: why would anyone want to consume wheat again if it did? CD is only one of the many charges on the wheat rap sheet.

      Contemplating more broadly, there is anecdotal evidence that some auto-immune conditions can be arrested or reversed by first fixing the leaky gut. This very likely requires that antibody titers recede. That’s a very slow process; months at least if not years. How long is a tetanus shot effective?

      But to circle around to the article topic … antibiotic use probably has multiple hazards due to nuking the gut biome, with a hypothetical enabling of CD being a relatively minor one in my view. And it’s not just prescribed ABs that are a problem – gratuitous OTC ABs abound (like triclosan in oral products). Many foods also are gut biome antagonists (and I’d include wheat on that list, entirely apart from it’s effect on tight junctions).

      • “Probably not, sort of by definition.”

        Definitions change. See Fasano’s work. Celiac used to be, “by definition” a rare disease. Until he changed the definition.

        • Even before I read some of Fasano’s papers, my position was:

          We are all celiac; it’s just a matter of degree and decades.

          Even if Big Gene™ mutates a gluten-free wheat (and they are working on it), I wouldn’t eat it. There are just too many other problems with it, going back to einkorn.

  17. Do you think its possible that it could be the spread of a pathogen?
    Maybe some kind of virus?

  18. My own personal story starts when I still lived in the UK, sometime in 2000. I became infected with something in my stomach/gut that made me sick for 2-3 days. The doctor prescribed antibiotics. It could have been a run of the mill bug, if it wasn’t for a very weird… dream I saw during the infection: a serpent taking rooting place in my stomach. I took that as a sign, and I wasn’t wrong.

    After that infection, everything changed in my life.

    Fast forward 11 years, I now live in the US, and I’m near death. It’s been 11 years of severe illness. At that point, in 2011, I had given up, and was even thinking that “I lived a good life, whatever comes, comes, I accept it…”. Death was looming and I still didn’t know what from. The blood test for celiac had come negative in 2003 (only to be told many years later that the blood test is not accurate), and the *various* doctors telling me that “it’s just stress” (really??). In the years followed I tried a gazillion antibiotics, got C.Diff, etc etc etc. Nothing worked.

    I went Paleo as a last ditch effort, and voila, all my symptoms disappeared within 3 days! I felt so good, as I haven’t felt for many years! I clearly remember the day No 3, I was coming back from Europe (I was there to say a final goodbye to my family), and in the airplane everyone looked tired and sleepy. I was full of energy, listening to music, and banging my head to the rhythm!

    My husband, looking at me that day, told me afterwards: “after seeing how you felt in the plane, I suddenly knew that this was the solution for you”.

    A year later, in 2012, 23andme’s DNA result revealed that I was 30x more likely to have celiac than the average population.

    Looking back, I should have seen that it was just plain old celiac, given that I had ALL the standard symptoms, but I chose to believe that darn inaccurate blood test. Doctors never asked me to do an endoscopic biopsy, which would have shown the problem, no doubt.

    So anyway, all is good now. I’m now 42 years old, and I’m hoping to become a mom. I could not become a mom earlier because my health had taken such a beating that I would either die giving birth or the baby would have been super-unhealthy (or both). I’m just hoping I didn’t make it out of hell too late.

    • @Eugenia
      I have all the complications from Celiac but don’t have Celiac. I also have the gene for Celiac. Now they are saying SIBO causes malabsorption, with the same complications/symptoms as celiac which is osteoporosis, autoimmune diseases, etc. But celiacs also have SIBO. My allergist says I have gluten sensitivity, but Dr Fasano says gluten sensitivity doesn’t produce autoimmune diseases. My daughter has Hashimoto’s and I have an undx’d thyroid condition with intermittent Lupus diagnosis and Spondyloarthritis (Inflammatory arthritis). I’m too sick to work yet I can’t go on disability without a diagnosis of something. It’s hard to heal your stomach when you have SIBO and multiple food allergies cause you can’t eat fermented foods.

      All of this started after I was hospitalized for an infection and given IV antibiotics.

    • Cheryl, was your 23andme done when they could still do some interpretation? I just got mine back and I have run it through a few online filters, but I am curious to get more information from it. Thanks!

      • I know this isn’t what you’re asking but Prometheus are quite a good on-line service for interpreting 23andme’s data.